[Tethered cord syndrome of adult onset: report of a case and a review of the literature].

ABSTRACT

A 47-year-old female was admitted with complaints of spontaneous pain at the medial surface of the right thigh, and worsening of urinary incontinence and weakness of the legs. These phenomena had been noticed previously 20 years ago, and again 10 years ago, respectively. There was a scar like skin abnormality of 4 X 6 cm over the lumbosacral region. Compression on this region induced neuralgic pain around the anus radiating down to both legs. Neurologically, weakness of the legs, sensory impairment on the L2-S5 dermatomes and urinary incontinence were recognized. Plain X-P revealed spina bifida on the lower lumber and sacral vertebrae (L4-S1), where a low density mass was found by spinal CT. Metrizamide CT myelography and MRI disclosed medullaris to be low and the spinal cord to be elongated. There was a meningocele surrounded by subcutaneous lipoma at the caudal end of the spinal cord at L5 level. Upon operation, a meningocele containing neural elements and adherent to the intra and extra-dural lipoma was found protruding through the laminar defect. Lipoma was removed partially. The conus medullaris and cauda equina were freed from the surrounding tissue. Dural plasty using the Lyodura was made. Postoperatively, the pain disappeared and her gait disturbance and sensory impairment were significantly improved, but urinary incontinence remained unchanged. Fifty-six cases of tethered cord syndrome of adult onset were reviewed from the literatures. Clinical symptoms, etiologies of the tethering, surgical outcomes and factors causing symptoms were discussed.(ABSTRACT TRUNCATED AT 250 WORDS)